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June 2, 2017

Letter Opposes Legislation that Repeals Medicaid Expansion

The Disciples Center for Public Witness joined other people of faith to oppose any legislation that repeals Medicaid expansion or institutes a Medicaid block grant or per capita cap. Read the letter below:

Dear Senator/Representative:

We represent religious
organizations, denominations, and faith traditions from across the spectrum. We
are united in a shared commitment to prioritize low-income, sick, elderly,
disabled, and vulnerable populations in the health care decisions before
Congress. Our scriptures affirm our moral responsibility to ensure all may live
with dignity and the opportunity to recognize their full potential. Access to
affordable, quality health care should not and cannot be a privilege; it is a
requirement rooted in faith to protect the life and dignity of every person.

We have grave concerns about the
future of the Medicaid program under current proposals to repeal and replace
the Affordable Care Act. We urge you to maintain the Medicaid expansion and
protect Medicaid from any harmful structural changes or federal funding cuts. We
strongly oppose any legislation that repeals the Medicaid expansion or
institutes a Medicaid block grant or per capita cap.

Medicaid enables one in five
Americans to access quality health care and live with dignity. Medicaid covers
populations our scriptures and faith traditions call on us to prioritize and
care for: low-income children, seniors, and people with disabilities. Through
the Medicaid expansion, 11 million low-income individuals were able to access
quality, affordable coverage. But proposals to eliminate the Medicaid expansion
and to institute a per capita cap would make individuals often in most need of medical
care the least likely to get it. The Congressional Budget Office estimates that
eliminating the Medicaid expansion and instituting a per capita cap, as under
the American Health Care Act, would cause 14 million people to lose their
Medicaid coverage within the decade.

Medicaid is a lean and efficient
program. While Medicaid spending jumped to 10.5% in 2015 due to the expansion
under the Affordable Care Act, spending dropped to 5.9% in 2016 and is
projected to grow by just 4.5% this year.[1]
Medicaid disproportionately covers many people with complex needs for health
services and long-term care, particularly the elderly and people with
disabilities, yet spending per person is lower than the private market and
Medicare, mostly because of its lower administrative costs and provider
payments. Furthermore, when adjusting for the greater health needs, Medicaid
spending per person is an estimated 25% lower than in the private market.[2]

Medicaid, especially through
improvements in the ACA, is increasingly a powerful tool in addressing the
tragic opioid epidemic around the country. Medicaid and CHIP cover a third of
people with opioid addictions, and Medicaid covers a variety of treatment
services, including inpatient services and detoxification, partial
hospitalization, intensive outpatient, and case management, depending upon the
state.[3]
The U.S. Surgeon General found that the Medicaid expansion enabled many people
with substance use disorders to access health coverage and treatment services.[4] In
states that took the Medicaid expansion, the percentage of people with
substance use or mental health disorders who were hospitalized but uninsured
dropped from about 20 percent in 2013 to 5 percent by mid-2015.[5]
Repealing the Medicaid expansion and capping the program would reverse and
severely restrict states' ability to respond to the opioid crisis.

Medicaid has an especially profound
impact in rural communities and in Indian country. Close to 1.7 million people
in rural communities gained health coverage under the Medicaid expansion.[6]
People in rural areas are more likely to be covered by Medicaid, and Medicaid
cuts would disproportionately affect these communities. Furthermore, the
Medicaid expansion has been an enormous assistance to rural hospitals’
financial stability. Between 2013 and 2015, uncompensated care costs as a share
of hospital operating budgets fell by about half in Medicaid expansion states.[7]

American Indians and Alaskan
Natives have some of the worst health disparities and poorest access to health
services in the nation, due partially to decades long underfunding of Indian
Health Services. Given the disproportionately high rates of poverty among
American Indians and Alaskan Natives, the Medicaid expansion provided arguably
some of the largest gains for Indian health within a generation.[8]
Repealing the Medicaid expansion would reverse these gains. Furthermore,
instituting a per capita cap could jeopardize Tribes' access to Medicaid
funding as they would become dependent on states identifying and passing through
the funding. Tribes often have difficulty in getting states to pass through block
grant funds to them.[9]

Rolling back the Medicaid
expansion, regardless of whether it is next year or within three years, would
leave millions without access to affordable coverage, and states would be
unable to make up the difference. Instituting a per capita cap or block grant would dismantle the federal guarantee and undermine the
program in a way it would not recover from. A per capita cap would prevent
states from addressing the next opioid epidemic or Zika outbreak. Without
addressing the underlying causes of growing health care costs, a per capita cap
simply cuts federal funding for the program, compounding dramatically over
time. Lower federal contributions shift costs to states which are then forced
to cut services, eligibility, and/or provider payments. The only added
flexibility given to states through a per capita cap is the flexibility to cut
more people and more services from the program. No formula or indexing calculation solves these problems. A vote to institute
a per capita cap is a vote to dismantle the program and shift billions of
dollars of health care costs onto states.

Real problems exist within
America's health care system and with the Affordable Care Act. Congress and the
administration should act to stabilize the individual market and lower costs.
However, Medicaid is unrelated to these problems and should remain off the
table in any negotiations to repeal and replace the Affordable Care Act. The
proposed cuts to Medicaid would exacerbate health care affordability and
accessibility problems by dramatic amounts. They would turn our country farther
away from health, farther away from our values, and farther away from a just
society. We call on you to prioritize those populations at greatest risk and oppose
any cuts to Medicaid. We urge you to
oppose any legislation that does not maintain the Medicaid expansion and
institutes a Medicaid per capita cap.